Goal: The patient reports increased comfort and decreased pain; and shows no signs of adverse effects, oversedation, or respiratory depression.
1. Check the medication order against the original medical order according to agency policy. Clarify any inconsistencies. Check the patient’s chart for allergies.
2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.
3. Prepare the medication syringe or other container, based on facility policy, for administration. (See Chapter 5, Medications, for additional information.)
4. Perform hand hygiene and put on PPE, if indicated.
5. Identify the patient.
6. Show the patient the device, and explain the function of the device and reason for use. Explain the purpose and action of the medication to the patient.
7. Close the door to the room or pull the bedside curtain.
8. Complete necessary assessments before administering medication. Check allergy bracelet or ask patient about allergies. Assess the patient’s pain, using an appropriate assessment tool and measurement scale. (See Fundamentals Review 10-1 through 10-6.) Put on gloves.
9. Have an ampule of 0.4 mg naloxone (Narcan) and a syringe at the bedside.
10. After the catheter has been inserted and the infusion initiated by the anesthesiologist or radiologist, check the label on the medication container and rate of infusion with the medication record and patient identification. Obtain verification of information from a second nurse, according to facility policy. If using a barcode administration system, scan the barcode on the medication label, if required.
11. Tape all connection sites. Label the bag, tubing, and pump apparatus “For Epidural Infusion Only.” Do not administer any other narcotics or adjuvant drugs without the approval of the clinician responsible for the epidural injection.
12. Assess the catheter exit site and apply a transparent dressing over the catheter insertion site, if not already in place. Remove gloves and additional PPE, if used. Perform hand hygiene.
13. Monitor the infusion rate according to facility policy. Assess and record sedation level and respiratory status every hour for the first 24 hours, then at 4-hour intervals (or according to agency policy). Notify the physician if the sedation rating is 3 or 4, the respiratory depth decreases, or the respiratory rate falls below 10 breaths per minute.
14. Keep the head of bed elevated 30 degrees unless contraindicated.
15. Assess the patient’s level of pain and the effectiveness of pain relief.
16. Monitor urinary output and assess for bladder distention.
17. Assess motor strength and sensation every 4 hours.
18. Monitor for adverse effects (pruritus, nausea, and vomiting).
19. Assess for signs of infection at the insertion site.
20. Change the dressing over the catheter exit site every 24 to 48 hours or as needed per agency policy using aseptic technique. Change the infusion tubing every 48 hours or as specified by agency policy.
Subscribe to:
Post Comments (Atom)
0 comments:
Post a Comment